Dear Bill | What Percentage Will Pay Cash?

Posted by Bill Esteb on Jan 13th 2023

Dear Bill

What percentage of people will be willing to pay cash up front and then send their own bill in to their insurance carrier to get reimbursed? Are most, okay? Or is it only a small percentage?

The short answer? Impossible to know because there are so many variables. Among them:

  • Chiropractor personality – sympathetic, compassionate?
  • Chiropractor philosophy – finite/infinite, short-term/long-term?
  • The patient's office experience – caring without caring too much?
  • The patient's income – how much margin do they have?
  • Why did they choose you – referral, coupon, insurance, reputation?
  • How much patients value health – available for wellness?

Many patients have been trained by their medical experiences to wave their insurance card and expect their insurance to pick up most of the tab. Since they have insurance, they want to use it. Of course. However, that doesn't mean you have to accept assignment. After all, you didn't coach them as to which carrier to go with.

When you accept assignment, you've become the third party! You're at the mercy of the largess of the insurance carrier, leery of your fiduciary interest in their relationship with the patient. All while exposing yourself to having to return the money later due to the antics of commission-based post review auditors.

I'm loath to share this work around used by some practices, but you may find it helpful.

What some practices have done to soften the financial implications of care is to use the patient's credit card billing cycle to buy some time until the patient gets reimbursed.

For example, let's say the closing day of the billing cycle of the credit card the patient nominates to use for their care is the last day of the month, let's say January 31.

After the billing cycle closes on say, February 1, you charge their card for their January care and provide a superbill. They submit their claim to their insurance carrier.

You've been paid for January and the patient doesn't have to pay their credit card until sometime in March. Many patients will get reimbursed by their carrier by then, or soon after that March payment is due.

Rinse and repeat.

Try it with a willing patient or two before you roll it out as your new practice procedure!

Granted, this isn't very elegant, but so many people suffer from financial fragility these days. Lacking an emergency fund to pay for their unplanned episode of low back pain, I don't have a better solution, unless they can qualify for Care Credit or something similar.

If their credit cards are maxed out, they obviously have bigger problems. (Their health issues may very well be related to the stress of lacking margin in their life!) You might decide that they are your pro bono case for the month.

Still another approach is to reduce your price while maintaining value. Resort to lowering your price only if you run out of other options. The key is to maintain the perceived value of an adjustment. Here's an example. Let's say you charge $50 per visit:

"Mrs. Jones our published fee for a typical visit is $50. However, you've mentioned that it would be a financial hardship, making the care you need out of reach. Now, because you sincerely want your health back, let me do this: You buy a visit. Then I'll buy you a visit. You buy a visit and then I'll buy a visit until we get you out of the woods. That should make your budget go further."

While this makes the effective cost of an adjustment $25, if asked by friends what their chiropractic care costs, they are more likely to say $50.

If you want to add some fine print about following your recommendations, keeping visits, etc. you can. But that should come across in your ground of being and shouldn't have to be spelled out.

The key is to never become the patient's bank. If you're inclined to bankroll their care on credit, at least set an agreed upon “credit limit” that will curtail their care until they resolve.

Hope that helps. Thanks for the question!

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